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While most cases of gonorrhea in the United States are still curable, some strains of the bacteria have developed antibiotic resistance.

Dr. David M. Phillips/Getty Images

April 2, 2018

In news likely to send chills through public health circles, an article published in March 29, 2018, in Health Protection Report by Public Health England details what they call the “first global report” of a person infected with the gonorrhea bacteria (Neisseria gonorrhoeae) who failed to improve with the latest antibiotic regimen.

The man, who went for medical care in England in early 2018, has a female partner in the United Kingdom, but also had sex with a woman in Southeast Asia a month before developing symptoms.

“This is a small red flag on the horizon,” says H. Hunter Handsfield, MD, professor emeritus of medicine at the University of Washington Center for AIDS and STD in Seattle, and a consultant for the Centers for Disease Control and Prevention (CDC) and the American Sexual Health Association.

“To date there have been very few infections like this documented in Western Europe or North America,” he says. “It’s a reminder of a scenario — and a possibility — that has been known and predicted for the better part of a decade.”

He adds that “people should be aware, but not panic; a single case doesn’t make an epidemic.”

Most Gonorrhea Still Treatable

Gonorrhea is a very contagious sexually transmitted disease that has most recently been treated with a combination of antibiotics. It’s spread through unprotected vaginal, oral, or anal sex, and can cause infections in the genitals, throat, and rectum.

Antibiotic resistance means bacteria, such as Neisseria gonorrhoeae, finds a way to skirt around and resist the effects of drugs designed to destroy it. Instead of dying, the bacteria keep multiplying inside the body, and causing illness.

“Little now stands between us and untreatable gonorrhea,” warns a video on the CDC website, which also says we are “currently down to one last effective class of antibiotics, cephalosporins, to treat this common infection.” Without these medicines, “we have few antibiotic options left that are simple, well-studied, well-tolerated, and highly effective.”

Noting some differences of opinion on what treatments will be available, Dr. Handsfield points to drugs coming through the development pipeline that could provide backup or alternatives for treating gonorrhea. Some medicines shelved in years past, he adds, might play a role in fighting the infection in the years to come.

For now, he adds, “every case in the United States is going to be pretty readily treatable.”

Throat Infections May Play a Special Role in Drug-Resistant Gonorrhea

Another important part of the story is where in the body gonorrhea infection takes hold. The U.K. man was treated for infection in his genitals as well as in his throat — but it was the throat infection that failed to respond to treatment.

“Throat infection is believed to perhaps play a special role in the evolution of hard-to-treat gonorrhea,” Handsfield says, because of the kinds of bacteria found in that part of the body.

In fact, it’s possible that cases of antibiotic-resistant gonorrhea already have appeared here.

“Not all cases come immediately to light," Handsfield says. “If this guy had never been tested with a throat culture for oral gonorrhea, for example, the fact that he had failed treatment wouldn’t even be known.”

The immune system eventually clears gonorrhea on its own.

Steps to Avoiding Antibiotic-Resistant Gonorrhea

Sexual adventure–travel abroad, like what the infected man in the United Kingdom appears to have experienced, is relatively common, Handsfield says. And it poses risks that should be taken seriously.

“People should keep their guard up,” he says. Lower your risk for gonorrhea by using a condom during vaginal or anal sex. Men should use a condom, and women a dental dam, when performing oral sex. Also, wash sex toys thoroughly.

In addition, think about the number of people you have sex with. Consider who is having sex with whom in “sexual partner networks” in cities and neighborhoods across the country.

“People usually have one or two partners," Handsfield says. In public health circles, “our single biggest fear is if one partner with gonorrhea has 20 partners. Then it can spread very rapidly.”

If you develop symptoms of infection — men may have genital discharge and painful urination, and women may have no symptoms at all — see a doctor. And if you’re diagnosed with gonorrhea and get antibiotics to treat the infection, follow instructions carefully about how to take the medicines.

Gonorrhea resistance “is simply one piece in overall story about rising antibiotic resistance,” Handsfield adds. People should avoid pressuring doctors for antibiotics to treat viral infections, for example, and promptly toss out unused antibiotics. On a larger scale, society needs to rethink antibiotic use in agriculture and meat production.